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When a group of Amish Knox County residents returned from a humanitarian trip to the Philippines
in late March, two young men became seriously ill and went to a hospital in nearby Holmes
County.

But they weren’t told they had measles. Instead, they were told they had Dengue fever, said
Tobias Yoder, who organized the trip.

Yoder and two of his brothers are among at least 14 Amish people sickened in a measles outbreak
that health officials discovered this week.

Yoder and one brother were the second two to become sick, about 13 days after the first two men
fell ill, he said. A doctor told Yoder’s brother that he, like the others, had Dengue fever, a
mosquito-borne illness, Yoder said.

“We thought this is amazing that four of us got a mosquito bite, and I’m not ever going to the
Philippines again,” Yoder recalled yesterday. “Then last Saturday, about six more cases turned up
and we said, ‘What’s happening here?’ ”

They called the Knox County Health Department, which uncovered a measles outbreak.

“We were contagious unknowingly and exposed a fair amount of people,” Yoder said.

Officials at Pomerene Hospital, where the men were treated, weren’t available to talk about the
situation last night.

Dr. D.J. McFadden, health commissioner in Holmes County, said the doctors at the hospital saw
symptoms — including low platelet counts and severe abdominal pain — that led them to think they
were dealing with Dengue, which is common in the Philippines. People who have Dengue fever also
develop a rash, as do people with measles.

Yoder, who is 33 and whose wife, Fannie, is now experiencing measles symptoms, said the Amish
community that he grew up in is not religiously opposed to vaccines. Some do, however, opt out of
shots.

He said he asked about any special vaccines that his group might need before traveling to the
Philippines, but the MMR (measles, mumps and rubella) vaccine wasn’t suggested. He had no idea
there was an ongoing and deadly outbreak of measles in the Philippines. Had he known, Yoder said,
he would have been vaccinated.

Some of the Amish travelers did get tetanus shots, said Knox County Health Department
spokeswoman Pam Palm.

Almost every unvaccinated person who comes in contact with measles will be infected. It can be
deadly, particularly in young children and babies. About a third of those infected will have
complications. Pregnant women are at high risk because measles can cause miscarriage and premature
delivery.

Symptoms usually show up a week to three weeks after exposure and include fever, cough, runny
nose, pink eyes and a rash. Those who are infected can transmit the disease four days before they
feel sick and four days after onset.

Health officials are scrambling to vaccinate residents. The state health department had ordered
more than 1,000 doses of MMR vaccine for Knox, Holmes, Adams and Ashland counties as of yesterday,
spokeswoman Melanie Amato said.

Palm said 161 people were vaccinated at a clinic in Danville yesterday, and 136 had shots on
Thursday.

In central Ohio, health officials also have been strongly encouraging the MMR vaccine, in light
of a mumps outbreak that started on the Ohio State University campus and has sickened 278 people as
of yesterday.

“Our vaccination rates are dismal,” said McFadden of Holmes County, where 78 people turned up
for a clinic yesterday. He said he was hoping to see more children.

Among newly enrolled children in the Holmes County public schools in the 2012-13 school year,
almost 8 percent had parents who oppose vaccines and asked for exemptions from shot requirements.
Statewide, that number is 1.5 percent.

“The only thing about my job that keeps me up at night is the fact that I have a large
unvaccinated population, and I have a large number of members of my community percentage-wise who
leave the country to do mission trips overseas,” McFadden said.

Christian Aid Ministries, which led the Philippines trip, has a group of 15 there now. McFadden
said he is trying to determine which travelers aren’t vaccinated and is working on plans to
quarantine returning residents if necessary. It can take up to three weeks for measles to appear
after an exposure.

There is no federal mandate that international travelers be vaccinated against diseases that are
spreading in their destination country, though the Centers for Disease Control and Prevention posts
travel notices about outbreaks and encourages vaccination, said CDC spokesman Jason McDonald.

Brian Fowler, chief of vaccine-preventable-disease epidemiology at the Ohio Department of
Health, said his department is talking with local health officials about how best to proceed in
light of large planned gatherings in Knox County, including a livestock auction scheduled for next
weekend.

“We’re trying to figure out where to go,” he said. “There’s a balance between the economics of
the situation and the human health aspect, and we want to make sure everybody is protected on the
health side. We don’t want to overreact, but we don’t want to underreact.”